RN Care Manager, MLTC
Remote job after new hire completes 4 – 6 months hybrid training: 2 days in office / 3 days remote
Salary range: $85,000 – $105,000 based on education and experience
$15,000 Sign-on Bonus

Position Overview:
In this role, the employee conducts telephonic assessments of members’ medical, psychosocial, physical, and spiritual needs. They are responsible for developing, implementing, and monitoring person-centered service plans. Collaboration with the interdisciplinary care team, primary care physicians (PCPs), members, members’ representatives, and specialists ensures continuity of care across all healthcare settings. Utilizing benefit structures and community-based resources, they address members’ needs effectively. Additionally, they educate members on disease processes, preventive health measures, and interventions to enhance quality of life. The RN Care Manager must possess knowledge of and adhere to CMS/DOH regulations and policies.

• Completes initial telephonic assessments and reviews UAS -NY visit data as assigned by the Supervisor of Coordinated Care in accordance with departmental workflow. Utilizes completed assessments to develop a Person Centered Service Plan (PCSP)
• Completes all telephonic Care Plan assessments assigned within a given month for members
• For members enrolled into MAP or HF, RN Care Manager will review the initial packet within 7 business days of enrollment and initiate PCSP.
• For H3347-002 plan, RN Care Manager will complete care planning within 30 days of enrollment, but no later than 90 days
• Generate a comprehensive PCSP that addresses all aspects of member’s needs including medical, social, educational, psychosocial, financial, community based aspects of member’s care and other support services
• Assist the member to access all necessary covered services as identified in the Person Centered Service Plan (PCSP) and obtain needed medical, social, educational, psychosocial, financial and other services i support of the PCSP, irrespective of whether the needed services are included in the Benefit Package
• Identify opportunities to educate on care gaps (i.e. missing preventative health recommended screenings/testing/vaccinations) and collaborate with PCP, specialist, and/or pharmacist to address gaps and coordinate care
• Comprehensive Care Plan is completed and documented in the care management database with an error rate of less than 5%
• Supervisor of Coordinated Care in accordance with departmental workflow. Utilizes completed assessments to develop a Person Centered Service Plan (PCSP)

Qualifications:

• NY State RN license, BSN preferred
• Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice
• Prior experience in an interdisciplinary service delivery environment preferred.
• Working knowledge of Medicare and Medicaid regulations